Why we have so little faith in our healthcare system

A few years back, my father woke up one morning and found that he was bleeding from his nose. For a few days, he was having a mild fever, which none of us paid much attention to. So, he got himself admitted to a local hospital, where he was tested for dengue. However, the test came back negative, so they began treating him for viral fever. 

Two days later, he was showing all symptoms of dengue, and his platelet count was dangerously low. We took him to another specialised hospital, and for the next week, he fought tooth and nail with death. Eventually, he got well. We came to know that not only did the first hospital misdiagnose him, but the medicines they had given my father aggravated his condition. 

I was lucky to get my father back. But not everyone is. Recently, a man exposed one of the most prominent hospitals in Dhaka for the tragic death of their father due to alleged negligence. The father, a 79-year-old with a history of heart issues, opted for a minimally invasive TAVI procedure at the hospital after being assured of its safety. However, during the procedure, a tear in his heart caused severe bleeding, leading to complications. 

One of the main reasons is the lack of one-stop service in both public and private hospitals. The patients do not get a uniform treatment like that of abroad. Another reason is the high cost of treatment. Healthcare is getting costlier each year

Despite emergency open-heart surgery, he developed infections, pneumonia, and kidney failure, ultimately passing away after 34 days of suffering. The son blamed the hospital's lack of coordination, poor postoperative care, and failure to provide timely updates. 

Not even doctors are safe from such a tragic fate. On 25 June 2024, Dr Akifa Sultana Tumpa, a senior clinical pathologist at Shaheed Suhrawardy Medical College in Dhaka, allegedly died from anaesthesia complications during a laparoscopic surgery at a private hospital in Feni. 

Sometimes, such cases end up causing major clashes. On 1 September last year, doctors from both government and private hospitals went on an indefinite strike after allegations of medical negligence in the treatment of a private university student, who reportedly died due to improper care at Dhaka Medical College Hospital. 

This led to violent clashes, with doctors being assaulted, emergency gates being locked, and armed individuals storming the hospital. The doctors suspended emergency services, only resuming after the government promised better security.

Recently, the Bangladesh Bureau of Statistics (BBS) conducted this national survey at the request of the Health Sector Reform Commission. On 18 February, officials from BBS submitted the preliminary report of the survey to the Commission. The survey revealed that 38% of the people in the country face neglect, lack of care, or improper treatment when they go to hospitals for treatment. 

It is a serious number, given that according to the survey, about one in every three citizens has faced negligence or improper treatment. And it is faced surprisingly more by the urban population. 44% of urban residents and 36% of rural residents have raised this complaint. Moreover, these complaints are nearly equal among men and women. The complaints are also almost equally distributed across all age groups.

Dr Mohammad Mushtuq Husain, a public health expert and advisor, Institute of Epidemiology Disease Control and Research (IEDCR), thinks that the problem stems from something deeper. 

"It is part of our bigger public health issue. A huge part of the population cannot avail healthcare properly. If that is the case, then they will feel that they have been neglected." 

"It is important to make healthcare accessible to everyone," he added, "Otherwise, this problem will not be solved." 

It is a common complaint of the people that doctors do not spend enough time with patients. And it was revealed in the survey as well. 

Patients clearly stated how much time they expected from a doctor. 28% of the respondents said that a doctor should spend at least 20 minutes per patient in the outpatient department or chamber. 26% and 19% of the respondents, respectively, opined that 15 minutes and 10 minutes should be sufficient. 23% of the people said that doctors should spend at least 25 to 30 minutes with each patient. 4% of the respondents said that even five minutes or less is acceptable for doctors to see a patient.

A medicine specialist, currently working at the Dhaka Medical College blamed the poor doctor-patient ratio of the country for this: "Sometimes it gets hard to attend to the patients for a long time because there are only a limited number of doctors to take care of so many patients."

Dr Mustuq thinks that structuring our healthcare system from the root level can mitigate the problem of a low doctor-patient ratio. 

"We need to divide the healthcare system into primary, secondary and tertiary levels so that people can get better treatment and there is more discipline in the healthcare sector." 

Dr Abdullah Al Masud Shamim, a pulmonologist at the Dhaka Medical College and Hospital, said, "There will always be a level of dissatisfaction among patients regarding medical treatment. Even in western countries, you would find 10-15% of people expressing dissatisfaction. Having said that, sometimes our patients genuinely face medical negligence or mistreatment at places. Even my close ones have experienced it." 

"One of the main reasons is the lack of one-stop service in both public and private hospitals. The patients do not get a uniform treatment like that of abroad. Another reason is the high cost of treatment. Healthcare is getting costlier each year." 

Indeed, out-of-pocket health expenditure in Bangladesh has increased dramatically. In 1997, it was 56%. In 2012, it increased to 62%. It rose to 67% in 2019. And in 2020, it was 69%. Soaring out-of-pocket healthcare expenses pushed 61 lakh Bangladeshis, or 3.7% of the population, into poverty in 2022.

Dr Shamim said, "Another major reason for the patients' feeling neglected is that the number of chronic diseases like diabetes, hypertension, or spinal issues is increasing. The patients keep taking medicines for years, seemingly to no avail. So he sometimes starts to think that the treatment he is getting is not enough." 

"The doctors are to blame too," he added, "sometimes we lose our temper or fail to give enough attention to a patient. In our defence, we have to deal with an unusually high number of patients every day due to the lack of doctors in our country." 

In the doctors' defence, it should be noted that medical negligence or mistreatment is a vague term that has been repeatedly used by unruly mobs to beat and assault doctors in the past. The doctors have expressed safety concerns time and again. 

Another doctor at Shaheed Tajuddin Ahmad Medical College, Gazipur, said on condition of anonymity, "The media sometimes report biased news about mistreatments for sensationalism. So people develop a natural distrust regarding the doctors due to the exposure to negative press coverage; hence the feeling of not getting enough care arises."

All complaints of neglect, lack of care, or improper treatment during medical care should be reported to the Bangladesh Medical and Dental Council (BMDC). To prove medical negligence, the plaintiff must show four things: the physician had a duty of care, the physician failed to meet the standard of care, the patient suffered an injury, and the injury was directly caused by the physician's actions or inactions. It is the plaintiff's responsibility to prove these points in a malpractice lawsuit.

And so, understandably, in Bangladesh, doctors are rarely held accountable for medical malpractice. In its entire history, the Bangladesh Medical and Dental Council (BMDC), which is in charge of monitoring physician conduct, has only disciplined 14 physicians and permanently revoked the license of one physician.

In comparison, over 52 lakh cases of medical malpractice are filed in India each year. From 2015 to 2019, the Indian National Consumer Disputes Redressal Commission (NCDRC) examined 253 medical malpractice petitions and granted compensation in 135 of them.

In Bangladesh, the majority of complaints wind up in court as either civil or criminal cases, and even then, doctors are rarely held ultimately responsible due to a lack of a sufficient legal framework. 

However, there is a lack of awareness among people about where to file such complaints. In the survey, 65% of the people said they do not know where to lodge complaints, while 11% of the respondents had no idea about it. However, 24% of the respondents said they know where to file complaints. The awareness rate is higher among men than women and higher among urban residents than rural residents. 

However, Dr Mustuq thinks that the main focus should be on how many complaints BMDC has settled by talking to both the patient and the doctor, not how many doctors have been punished. 

"If BMDC can sort things out between the complaining patients and the accused doctors by talking, it will be the best outcome. Not every medical negligence complaint is substantial. Sometimes, they stem from misunderstanding."